Provider Demographics
NPI:1609161884
Name:SMITH, HOLLY ALISE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:ALISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 SAND RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-4057
Mailing Address - Country:US
Mailing Address - Phone:407-718-0957
Mailing Address - Fax:
Practice Address - Street 1:432 SAND RIDGE DR
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-4057
Practice Address - Country:US
Practice Address - Phone:407-718-0957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH8409101YM0800X
FLMH11529101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health